KYUNG SOO KIM MD NPI 1558363119

NPI Information

NPI: 1558363119
Provider Name: KYUNG SOO KIM, MD
Classification: Internal Medicine - 207RC0000X
Entity Type: Individual

Specialization: Cardiovascular Disease

PECOS Registration: Yes

Address:
14049 E 13 MILE RD STE 1
WARREN, MI
ZIP 48088
Phone: (586) 415-0103
Get Directions

Kyung Soo Kim, MD is a cardiovascular disease internal medicine in Warren, MI. The provider is an internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. Kyung Soo Kim, MD NPI is 1558363119. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

14049 E 13 MILE RD STE 1
WARREN, MI
ZIP 48088-876
Phone: (586) 415-0103
Fax: (586) 415-0108

The NPI 1558363119 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/12/2005 and was last updated on 3/7/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207RC0000X	Internal Medicine	Cardiovascular Disease	4301032265	MICHIGAN	Yes
2	207UN0901X	Nuclear Medicine	Nuclear Cardiology	4301032265	MICHIGAN	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	060-507-4551	OTHER	MICHIGAN	BLUECROSSBLUESHIELD
2	OH-26467002	OTHER	MICHIGAN	MEDICARE ID

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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